Chiropractic and TMJ
Living in the fast paced world of Bellevue Washington, stress is a common part of our day. Job stress, family stress, traffic stress, and name it stress is hard to get away from. In my office I see a lot of the physical results from stress. One of the physical manifestations of stress that I see on a daily basis with my patient is TMJ.
What is TMJ? Great question! TMJ stands for temporal mandibualar joint, or your jaw bone and joints. Simply put, TMJ is pain the joint or joints of the jaw. It is a very painful condition that can affect the way you eat, talk and even sleep. Clenching and grinding of your jaw, which are common while under stress, is a common cause of this problem.
I see quite a lot of patients with TMJ in my practice and have found that it is very closely associated with conditions of the neck. As a chiropractor I first look to see if the joint has been misaligned, and if it has use very gentle steps to realign the joint. Many times this will help in eliminating TMJ pain, and symptoms.
I use very gentle steps to help create normal alignment in the jaw.Once aligned the next step is re-balancing the muscles so the TMJ symptoms do not come back. For this I use simple a home exercises. If you have TMJ and have found no cure it may be time to see a chiropractor. The testimonial below is from one of my many patients who have found relief while under my care.
"I have had pain from my misaligned jaw (TMJ) for years and years. I have tried mouth guards, massage, been to different doctors, stretching, etc. Nobody can help and they all refer me to oral surgeons (who want to break your jaw) but no insurance companies, medical or dental will cover anything to do with TMJ and even most doctors cringe and run away at the mere mention of it. I never thought Chiropractic treatments could help this sort of thing, but eventually out of desperation asked Dr. Weir if there was anything he could do. After our session I had no more pain and was able to fully open my mouth without it clicking or my joint popping out of place for the first time in over 10 yrs! - (plus, so far it's staying that way without falling right back out of place). He was more informative on things I can do to help reverse the damage (without surgery) than ANY of the "specialists" I have seen. I should also mention that he has a fantastic staff and the office is super comfortable. For the first time in a looong while, I feel hopeful that I won't have to live with this pain for the rest of my life. - thank you Dr. Weir!!! - C.B."
Imagine a camping trip..no electricity, no toilets, and cold sandwich's. Now imagine these conditions on a luxury cruise to the Mexican Riviera. This was the disaster that awaited Dr. Michael Weir and wife as they boarded the Carnival Splendor on the 7th of November. "We had been planning this trip for 9 months and were very excited to go on vacation with friends", said Michael Weir, owner of Back in Action Chiropractic in Bellevue WA.
After pulling away from the dock on Sunday afternoon, the couple and their friends enjoyed their first evening on the ship with a great dinner and live entertainment, unaware of what lay ahead the next day. Six o’clock the next morning, Dr. Weir was woken by a jolt, and rumble which shook the entire ship. “At first I thought it was just heavy waves, but as soon as the captain came over the loud speaker telling us there was a mechanical problem I knew something big was happening.” The loud rumble was the main engine room of the boat catching fire and frying the main electrical wires for all the ships power. The fire sent billows of smoke throughout the boat. “We had to leave our rooms almost immediately because of the amount of smoke that was flowing through the halls and cabins.”
As Dr. Weir recounts, "My main concern through the whole ordeal was the sanitation on the boat. Because of my public health courses in school I knew that a major concern in a disaster is the lack of public restrooms. When all of the toilets on the ship would not flush, I knew there could be a problem." With out the ability to flush any of the toilets on the ship most of the day Monday the smells of overflowing toilets started to become to much to bear. Much to the relief of his party and himself the toilets regained function by the end of their first day stranded at sea. "I truly felt that we were 3 to 4 hours from a sanitary disaster, if they could not get the toilets to flush."
"I was very impressed with how well the passengers on the boat responded to a bad situation. There could have been pandemonium, but every one stayed very positive. There were even nights that you would not have known that we were stranded at sea, people singing karaoke, dancing, and laughing." Making lemonade out of lemons is one of Dr. Weir's life philosophy's. "We can moan and groan, but in the end that does nothing to change a situation. We had fun in spite of the poor situation." Dr. Weir and his family were extremely happy to be home, but maintain that they have no reservations about going on another cruise in the future. "It was a big disappointment to close my office and not be available for my patients, only to have a week stranded at sea, but we made it home safe, and we get another cruise out of the deal."
With more and more people taking up recreational running in the US, the number of running associated injuries have also increased. Commonly reported cases include: shin splints; patellofermoral pain syndromes; Achilles tendinitis; flat feet; and compartmental syndromes and stress fractures. All these injuries are a result of cumulative stress reactions to soft tissues and bones. While running, the musculoskeletal system may absorb up to 250-300% of the runner’s weight on the heel strike [1,2,3], and this exerts stress on the body.
Chiropractors are generally contracted to help alleviate pain and non-specific symptoms associated with running, usually from the gradual onset of regular stress on the soft tissues and bones. If these symptoms are caught early, they can then be effectively managed and reduced in a short period of time . Chiropractic treatment can help excessive pronation , the inward rolling of the hind foot and the midfoot beyond the acceptable parameters of general walking and running; prolonged internal rotation of the internal extremity , the inward rotation of the femur, which transmits stress to the pelvic region; and excessive supination , and those with very high arches who are very sensitive to stress reactions and fractures.
While chiropractic treatment can help with pain and injuries, its biggest advantage to runners and athletes is preventive care. Many runners, athletes and non-athletes may ask – why pay for chiropractic treatment when there is no pain to treat? It’s much easier to maintain good health and prevent injury than to treat somebody already in pain. The danger with running injuries is that they are likely to be caused by repetitive stress and alignment problems that take time to develop, and an even longer time for the pain to start. If our bodies were designed with perfect alignment, then we would be able to cope with the regular stress running delivers. However, very few of us do have perfect alignment, and in many cases those with flat feet or high arches are at risk to extra cumulative stress to the body. 
In preventive cases, a chiropractor can give a good overall evaluation, teaching the patient how to prevent injuries and maintain good alignment – thereby reducing the chance of injury. For those looking for preventive treatment, your chiropractor can help assess and evaluate your condition by offering scans of your feet, testing for strength imbalances and an analysis of your posture. In addition, the chiropractor can also suggest a program suited to your needs to prevent injury in the future.
 Lutter LD. Foot-related knee problems in the long-distance runner Foot &Ankle 1980; 1:112-116.
 Robbin SF, Hanna AM. Running-related injury prevention through barefoot adaptations. Med Sci Sports Exerc 1987; 19.148-156.
 Cavanaugh PR, LaFortune.MA. Ground reaction forced in distance running. Biomech 1980; 13:397-406.
 Griffith., HJ et aZ Magnetic resonance spectrum of stress injury to bone and ib clinical relevance. (in press) Presented at Annual Symposium of Am Coll Chiro Radiol, 1992.
 Michaud TC. Recurrent lower tibial stress fracture in a long-distance runner. Chino Sports Med 1988; 2(3):78-87. 18. Cavanagh PA The shoe ground interface in running. Symposium on the foot and leg in running sports, n.d.
 Schafer RC. Clinical Biomechanics Musculoskeletal Actions and Reactions. Baltimore: Williams & Wilkins, 1983. 21. Greenawalt MH. Spinal Pelvic Stabilization (4th ed.). Roanoke: Foot Levelers, Inc., 1990.
 Subotnick SI. Sports Medicine of the Lower Extremity. New York: Churchill Livingstone, 1989:164.
 http://www.campanellahealthcenter.com/uncategorized/why-chiropractic-care-is-important-for-runners/ accessed September 2011
Are You Suffering From Migraines?
Migraine sufferers have to endure a pain that is recurring, severe and can last up to 72 hours. Warning signs such as an “aura”, which is a type of visual disturbance, and nausea, sometimes accompany migraines. Many sufferers find that conventional medicine and prescription drugs offer little relief from their condition, and many are turning to alternatives methods of treatment in order to manage the pain. I have found that one such alternative is chiropractic treatment.
A holistic approach to pain relief, chiropractic treatment focuses on aiding numerous health issues through massage, spinal manipulation and adjustment of the body’s soft tissues and joints, predominantly in the back. But is it effective against migraines?
In February 2000, a study published by Dr. Tuchin et al.  cited the possible benefits of chiropractic treatment in alleviating or easing both the pain and frequency of recurring migraines. The study used a sample of 127 migraine patients, all of whom suffered from at least one migraine per month; this sample was divided into two groups – one control group who received inactive treatment, while the other group received chiropractic treatment, focusing on aligning and treating specific areas of vertebral swelling and misalignment. The study concluded that those who received chiropractic treatment experienced subsequent improvement in the duration of the study, showing reduced pain and frequency of their migraines within two months of treatment. The latter group also reported a decline in the need of migraine medications. Further results from the same study found that one in five sufferers from the chiropractic treatment group had a 90% reduction of migraine frequency, while 50% found significant improvement in the severity of their migraines.
Recent studies conducted by R. Bryans et al. published in 2011 , concluded that chiropractic care, including spinal manipulation, were found to improve both cerviocogenic headaches as well as migraines. A systematic literature search on controlled clinical trials on the topic of migraines and headaches involving chiropractic treatment, published through August 2009, was conducted using a selection of medical and alternative therapy databases. Research found that chiropractic treatments such as spinal manipulation and massage could significantly help patients who suffer from chronic or episodic migraines, whereas sufferers of tension-type headaches did not respond to such treatment.
While using alternative methods of treatment such as chiropractic care can help sufferers to gain more control over their migraines, it should be treated as another form of support or extra help, instead of completely overlooking conventional medical care.
 P.J. Tuchin, H. Pollard, R. Bonello, A randomized controlled trial of chiropractic spinal manipulative therapy for Migraine. Journal of Manipulative and Physiological Therapeutics, Feb. 2000: Vol. 23, No. 2, pp91-95.
R. Bryans et al., J Manipulative Physiol Ther. 2011 Jun;34(5):274-89. doi: 10.1016/j.jmpt.2011.04.008.
A triathlon is an athletic event incorporating back-to-back running, cycling and swimming. Triathlons exert great strain on the body, which may challenge athletes on both physical and mental levels. The extreme training a triathlete must endure can put the body under great cumulative stress, and it’s not uncommon for the athletes to suffer from a broad range of injuries and overuse stresses.
There are numerous worldwide triathlon events, such as Ironman, Half-Ironman, Olympic and Spring. The majority of these events advocate the use of chiropractic care to aid not only in treating injuries, but also to improve performance. Chiropractic care offers the possibility of enhanced finishing times and a greater likelihood of triathletes finishing events.
Chiropractic treatment is a practice that focuses on the neuromuscular skeletal system and its use optimizes biomechanics. For these reasons, chiropractic care is ideal for athletes looking to treat or prevent injuries.
One type of chiropractic treatment used by many triathletes is the “Active Release Technique,” which is a form of soft tissue treatment based on an advanced movement massage system. It is very effective in locating and treating the cause of soft tissue conditions. Active Release Techniques are used in most of the large name triathlons. Many triathletes suffer from injuries attributed to repetitive strain and stress, since excessive training can result in muscle restrictions due to adhesion formation. Before treatment takes place, a biomechanical analysis of the athlete is conducted to determine the exact location of restrictions in the body along the kinetic chain. Active Release Techniques focus on specific tissues that have become restricted physically, and are then manipulated back into their original texture, tension and position. Once the soft tissues are repositioned, specific exercises are then carried out in order to aid the recovery of damaged tissues. Unlike most treatments, treating the injured triathlete with chiropractic care does not require extended rest periods before improvements are seen. It is very common that injured athletes who receive the Active Release Technique show signs of improvement in just a few sessions. For those who are looking to invest only in preventive treatment, improvement in performance is also achieved in the span of a few sessions.
A possible reason that chiropractic care prior to an event can result in performance enhancement may be that spinal adjustments improve the body’s maximal oxygen consumption ability. Since prevention is easier than treatment of an injury, many professional athletes invest in preventive and performance enhancing chiropractic treatment.
 http://www.kinetichealth.ca/4-Triathalon.html Accessed September 2011
 http://www.bthconline.com/sport-injuriesperformance.html Accessed September 2011
Good spinal health is built from the ground up, starting with the feet. For years medical researchers and healthcare providers have recognized that problems there can cause posture changes that eventually trigger a variety of musculoskeletal issues in other parts of the body (particularly the ankle, knee, hip and back). Studies have also shown that even slight foot problems can negatively affect athletes’ performance and predispose them to a broad range of sports-related injuries.
What Are Orthotics and How Can They Help?
Orthotics are shoe inserts that are specially designed and manufactured to correct an abnormal or irregular walking pattern by promoting proper alignment and balance. They’ve improved the quality of life for millions of people, and it’s become very common for physicians to recommend them to address many different patient needs:
• Reducing pain and/or fatigue
• Providing targeted foot support
• Relieving pressure or stress on an injured or sensitive area
• Preventing or limiting deformity
• Improving foot positioning and function
• Restoring balance
• Reinforcing or supplementing other therapies (particularly chiropractic adjustments)
Foot orthotics are medical devices that can significantly change the way a person stands, walks and runs (and therefore the way his or her body absorbs and distributes related forces). For this reason, it’s important that the person wearing them clearly understand their benefits, risks and limitations. It’s also important that the person use them correctly.
What Every Patient Should Know About Orthotics
1. There is no “one-size-fits-all” answer when it comes to orthotics. What works for another family member or neighbor will probably not work for you! Getting the right prescription for your particular needs is all about working effectively with your healthcare provider to define your own goals and develop a complete understanding of your foot’s unique structure and function. For instance, orthotics can be very sport-specific—the performance requirements of a hiker will not be the same as those of a skier or a football player.
2. Not all orthotics are created equal, and the differences matter. The prefabricated orthotics that can be purchased at shoe stores, pharmacies and sporting goods stores are not the same as the custom orthotics prescribed by a healthcare provider. Do not confuse them! Mass-produced products are tailored for the “typical” foot and are unlikely to address problems specific to any one individual’s foot. In some situations, such products can actually make a medical condition worse, cause new problems or increase the risk of injury. So while they’re usually less expensive than custom orthotics, they may not actually solve your particular problem.
3. Orthotics don’t actually correct foot or ankle problems. They are intended to realign the structures of the foot to improve function, reduce pain and decrease the risk of injury.
4. Needs can change over time and your orthotics should too. The structure and function of the foot can change as people age. So too can people’s lifestyle and priorities. Your healthcare provider can work with you to ensure that your prescription is still the right one for you.
5. Long-term use of orthotics may pose its own risks. Any time that you provide outside help to the structures normally responsible for supporting and moving parts of your body (casts or braces are good examples), you are essentially asking them to do less. And if you provide that help over a sufficiently extended period, you run the risk that your bones, muscles and connective tissues may become weaker as a result. The unintended consequence is that you may actually become less capable and more reliant on your devices to do the work your body used to do. Your healthcare provider will talk with you about how to use your orthotics correctly and manage any long-term risk that he or she believes may exist.
6. Prescribing orthotics is arguably as much an art as a science. Don’t underestimate the role of professional in prescribing orthotics. Experts acknowledge that there are few widely-accepted standards and that we can’t always predict successfully how an individual will respond to a particular prescription. In fact, recent research has demonstrated that individuals with the same condition can respond very differently to identical orthotic therapy. There’s even evidence that the same patient can respond to a prescription inconsistently or can respond just as favorably to two entirely different (even contrary) prescriptions. This means that some trial and error may be necessary to get the results both you and your healthcare provider are looking for and that good communication is critical. Without accurate and timely feedback about how well your orthotics are doing their job, it’s impossible to make the adjustments that will eventually lead to success.
How Your Bellevue Chiropractor Can Help
There’s a close relationship between the way your feet work and the way the rest of your musculoskeletal system supports your body. So even if your feet themselves don’t actually hurt, they could be contributing to other health problems that you’re experiencing. After your chiropractor has examined you carefully and talked with you about your situation, he or she can help you decide whether foot orthotics should be part of your broader treatment plan. Call our office today at 425-635-0495 to learn more.
References and Resources
Gina Kolata, Close Look at Orthotics Raises a Welter of Doubts. Orthotic Shoe Inserts May Work, but It’s Not Clear Why. New York Times Fitness and Nutrition. January 17, 2011. Accessed August 2011.
Nigg, BM et. al., Effect of Shoe Inserts on Kinematics, Center of Pressure, and Leg Joint Movements During Running. Medicine & Science in Sports & Exercise. February 2003. Accessed August 2011.
Best Foot Forward with Chiropractic. Journal of the American Chiropractic Association. January 2001. Accessed August 2011.
The B group of vitamins is probably the most commonly misunderstood of the vitamins, simply because the B vitamins are several distinct vitamins lumped together. Additionally, the fact that the vitamins in this group are known by both letter, number and name is confusing to many people. Here is a quick list of the B vitamins found in the Vitamin B complex group:
• B1 is also thiamin
• B2 is also riboflavin
• B3 is also niacin
• B5 is also pantothenic acid
• B6 is also pyridoxine
• B7 is also biotin
• B9 is also folic acid
• B12 is also cobalamin
You should note that there are four additional substances in the B complex group, though they are not known as vitamins. They are choline, lipoic acid, PABA and inositol. When you purchase B complex vitamins, these four will not be included. Furthermore, one or two of the recognized B vitamins may also be omitted. B5 and B7 are so widely available in food that most people get plenty of these vitamins even if they aren’t eating a healthy diet.
There are gaps in the numbers of the B vitamins because our understanding of them has evolved over time. Initially there was only a single B vitamin. Later it was recognized that what had been referred to as a single vitamin, actually had many components. These component parts where numbered 1,2,3,4, etc… Even later it was determine that some of these components (such as B4) did not meet the criteria of being a vitamin and they were dropped. That’s how we ended up with 8 B-vitamins with non-sequential numbers.
One thing that all the B vitamins share is that they are water soluble. Any excess vitamin B is not stored, but rather is excreted in the urine. That means that all the B vitamins need to be constantly replenished from our diets.
B vitamins are found in whole unprocessed foods including grains, meats and vegetables. In general, the more processed that food is, the lower the content of all the B vitamins. A daily multi-vitamin is a great way to ensure that you are getting all the B complex Vitamins your body needs on a daily basis.
One of the most commonly recognized uses of the B vitamins is an energy booster. Many popular energy drinks that claim a natural boost of energy without sugar or caffeine are high in B vitamin complex.
There are too many components in the Vitamin B complex to discuss the health benefits, deficiencies and Recommended Daily Allowance for the whole group in a single article. Look for future articles about each of these important nutrients.
If you have questions about your current nutrition and supplement plan, just ask. We are here to help!
B Vitamins MedlinePlus. (n.d.). Retrieved 8 10, 2011, from National Institutes of Health: http://www.nlm.nih.gov/medlineplus/bvitamins.html
Micronutrient Information Center. (n.d.). Retrieved 8 11, 2011, from Linus Pauling Institute at Oregon State University: http://lpi.oregonstate.edu/infocenter/vitamins.html
Have you ever found yourself tuning out information about nutritional supplements because it all seems confusing and contradictory? If yes, you are not alone. One headline says 'get more X' the next headline says 'be careful about too much X' and another says 'X supplementation not necessary at all'. Headlines are meant to sell newspaper and magazines. They report on what's new not necessarily what is backed by the most evidence. And, the stories are often selected based on findings that are contrarian or against conventional wisdom. After all, who is going to buy a magazine with the headline, "No change in guidelines – eating more plant-based foods is still good for you."
Consumers really need a reliable source of evidence-based recommendations for nutritional supplements. Since these are not regulated by the FDA, there isn't a government run website that you can count on to be unbiased. There are several private companies, non-profits and even individuals that claim to offer comprehensive unbiased information on nutritional supplements, but who has the time to sift through all of these to figure out whose information is the best?
At the risk of offending a number of other great sources, this article is a plug for the Linus Pauling Micronutrient Information Center at Oregon State University at http://lpi.oregonstate.edu/infocenter. Chances are this is a source you've never heard of or looked at, but you should.
The website describes the Linus Pauling Institute as a “source for scientifically accurate information regarding the roles of vitamins, minerals, other nutrients, dietary phytochemicals and some foods in preventing disease and promoting health”. As you can see from the description, their mission extends beyond nutritional supplements to also include whole foods. This is critically important because sometimes nutrients are more potent together (as in a food) than they are separately.
When you visit the website, you'll have a chance to subscribe to the newsletter near the top of the page. Do it. This isn't another email newsletter but rather a printed, bound newsletter sent to your house containing all of the Institute's latest research.
The folks at OSU are doing excellent work to bring us all trustworthy, evidence based recommendations on the tens of thousands of nutrients in our foods. Take some time to look at their website, bookmark it and share it with others. If there are concepts or terms you don't understand, feel free to ask us during your next appointment or send us an email.
If you are pregnant and suffering from low back pain, a neighbor or a friend has probably suggested you visit a chiropractor because a chiropractor was able to help them during their pregnancy. The discussion probably left you curious, is that good advice or just a single success story? Additionally, you may be wondering whether chiropractic is safe during pregnancy and how much low back pain improvement the average pregnant woman can expect to get.
After looking at several scientific publications on these exact topics, the appropriate conclusion seems to be that “chiropractic evaluation and treatment during pregnancy may be considered a safe and effective means of treating common musculoskeletal symptoms that affect pregnant patients. The scarcity of published literature warrants further research.” (Borggren, 2007)
So basically the answers are:
• Yes, chiropractic is safe during pregnancy.
• Yes, chiropractic helps common musculoskelatal probelms during pregnancy (including back pain).
• Your friends experience isn’t just one woman’s story. Many women are finding relief and the results are being sporadically published in medical journals too.
• More research under more controlled conditions is needed for the purposes of educating primary care physicians and obstetricians about chiropractic care during pregnancy.
Here are a few additional details about the prevalence of low back pain during pregnancy and the number of women being referred for treatment.
• 57 – 69% of women complain of low back pain during pregnancy
• Only about 32% of women report these symptoms to their primary doctor
• Only about 25% of primary doctors recommend seeking treatment for the pain.
Clearly this is a big problem with 2 in 3 having pregnancy-related back pain. Also a big problem is that they are generally not talking to their obstetricians and primary care physicians about it and that these professionals are not referring them to effective treatment options.
Chiropractic treatments can be quite effective for pregnancy-related back pain with just a few visits for the majority of women seeking help. In a small study of 17 women:
• Sixteen of 17 (94%) saw clinically important improvements in low back pain with chiropractic care.
• The average pain rating went down from 5.9 to 1.5 (on a scale of 0 to 10).
• It took an average of 1.8 visits and 4.5 days to get clinically important pain relief.
We hope this article gave you hope that many pregnant women do get significant, rapid relief from low back pain. If you are currently pregnant with low back pain, you probably have many questions not answered by this article. Perhaps you’ve never had chiropractic care before or you want to know how we adjust our techniques to work with pregnant patients. The best way to get answers to your questions is with an initial consultation. The only way for us to know whether you are a good candidate is for you to come see us, so call us today at 425-635-0495 for an initial appointment today!
Borggren, C. L. (2007, Spring). Pregnancy and chiropractic: a narrative review of the literature. J Chiropr Med, 6(2), 70-74.
Khorsan, R., Hawk, C., Lisi, A., & Kizhakkeveettil, A. (2009, Jun). Manipulative therapy for pregnancy and related conditions: a systematic review. Obstet Gynecol Surv, 64(6), 416-27.
Lisi, A. (2006, Jan-Feb). Chiropractic spinal manipulation for low back pain of pregnancy: a retrospective case series. J Midwifery Womens Health, 51(1), 7-10.
Stuber, K., & Smith, D. (2008, ul-Aug). Chiropractic treatment of pregnancy-related low back pain: a systematic review of the evidence. J Manipulative Physiol Ther., 31(6), 447-54.
Dr. Michael Weir